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STATE OF THE NATION:

Children’s food in England, 2018

CONTENTS

FOREWORD 3

ABOUT FOOD FOR LIFE 4

AT A GL ANCE – 5

a. What are children in England eating?

b. Has 2018 been a good year for children’s food?

INTRODUCTION 10

CHILDREN’S FOOD IN THE EARLY YEARS 13

CHILDREN’S FOOD IN SCHOOLS 17

CHILDREN’S FOOD OUT AND ABOUT 22

CHILDREN’S FOOD IN THE HOME 26

2018 TIMELINE 30

RECOMMENDATIONS 32

FOREWORD

As the public health community knows too well, changing the way that children eat is both very difficult and hugely important. Government initiatives focussed on childhood obesity have opened a welcome conversation this year about how that change might be achieved. This State of the Nation report makes an essential contribution to that conversation.

In particular, this report should be commended for re-framing the terms of the conversation, shifting the focus away from calories and individual nutrients and towards the need for proper nourishment provided through a balanced diet of fresh and minimally processed foods. Government efforts to remove sugar and calories from unhealthy ‘junk’ foods are helpful, but there is more at stake in children’s relationship with food and this report takes the broader view.

The report is published at a pivotal moment. The UK’s departure from the European Union is still in train and the details of our future relationship are yet to be agreed. Brexit poses potential threats to children’s food, particularly in the form of price hikes that could exacerbate household food insecurity. But as our government considers its priorities for domestic food policy outside the EU, there will also be the opportunity to do things differently and better. This report includes five recommendations for government action, all aimed at harnessing this opportunity.

These recommendations, if implemented by government, would make a real difference to children’s food in England. I am therefore delighted to provide the foreword for this State of the Nation report. I am convinced it will provide policy makers in government, head teachers and caterers, parents and all who are concerned about children’s food, with valuable insights into what children in England are eating and the vital changes that we now need so as to make it normal, easy and enjoyable for all children to eat well.

GABRIEL SCALLYVisiting Professor of Public HealthUniversity of Bristol and University of the West of England

FRUIT AND VEGETABLES ARE AN IMPORTANT SOURCE OF DIETARY FIBRE, VITAMINS AND MINERALS, BUT FEWER THAN

CHILDREN MEET THE FIVE-A-DAY TARGET.4

MORE THAN

OF THE VEGETABLES THAT CHILDREN EAT ARE PROCESSED, WITH

OF THE VEG IN CHILDREN’S DIETS COMING FROM PIZZA AND BAKED BEANS.6

STATE OF THE NATION: CHILDREN’S FOOD IN ENGLAND, 2018 | 32 | www.foodforlife.org.uk

ABOUT FOOD FOR LIFE

Food for Life is a Soil Association initiative that aims to make it normal, easy and enjoyable for children to eat well. We work with thousands of schools and nurseries across England, and with caterers, cafés and restaurants, to put healthy and sustainable food on the plate. We get people of all ages cooking and growing and out onto farms, so they have a positive connection with real food.

Over 10,000 schools and early years settings are serving meals certified to Food for Life Served Here standards. Food for Life Served Here provides independent endorsement that caterers and food providers are meeting nutrition standards and serving food prepared from fresh, sustainable and locally sourced ingredients.

Through our Food for Life awards we support schools and early years settings to put good food at the heart of a child’s day. The Food for Life Early Years Award supports nurseries and children’s centres with

training and resources to help them give every child an early introduction to fresh, healthy food through cooking, gardening and play. The Food for

Life School Award, widely commissioned by public health teams and taken up by schools across the country, reconnects children with where food comes from and makes it more likely they will leave with a happy, healthy relationship with food. Over 1,100 School Awards have been achieved and over 5,000 schools have enrolled in our network. Independent evaluation has shown that children in Food for Life schools are twice as likely to eat their five-a-day, compared to children in matched comparison schools.

Food for Life also works with universities, workplaces, hospitals, care homes and visitor attractions, on the high street, with local authorities, NHS Trusts and with entire cities, to make good food the norm in all the places where people live out their daily lives.

AT A GL ANCE –

ULTRA-PROCESSED FOODS UK families consume the most ‘ultra-processed’ diet in

Europe. 50.7% of family food purchases are ultra-processed, compared to 14.2% in France and 13.4% in Italy.1

Foods are ‘ultra-processed’ if they have been industrially- produced and employ undesirable additives to imitate the sensory qualities of natural foods.

Researchers have identified “a significant positive association” between the availability of ultra-processed foods and the prevalence of obesity and diet-related non-communicable diseases.2

FRUIT AND VEGETABLES Fruit and vegetables are an important source of dietary fibre,

vitamins and minerals, but fewer than one in 10 children meet the five-a-day target.4

Primary school children (aged five to 10) consume an average of 2.5 portions of fruit and veg each day, and secondary school children (aged 11 to 18) consume an average of 1.7 portions.5

More than one-third of the vegetables that children eat are processed, with 17% of the veg in children’s diets coming from pizza and baked beans.6

Primary school children drink more fruit juice than they eat either fruit or vegetables. This means that they are consuming sugar in the form of fructose but without the beneficial fibre of the fruit.7

Over the last decade, fruit juice consumption among children aged four to 10 years has almost doubled.8

Over 1,100 School Awards have been achieved and

over 5,000 schools have enrolled in our network.

UK FAMILIES CONSUME THE MOST ‘ULTRA-PROCESSED’ DIET IN EUROPE.

of family food purchases are ultra-processed, compared to

14.2% in France

13.4% in Italy.1

A. WHAT ARE CHILDREN IN ENGL AND EATING?

My favourite vegetable is peas and my favourite dinner is chicken nuggets, chips and broccoli. My least favourite vegetable is sweet potato because it’s too sweet.

ELEANOR, 8 9

Diets that include a lot of ultra-processed foods are intrinsically nutritionally unbalanced and intrinsically harmful to health… The best dietary advice is to base diets on fresh and minimally processed foods.

DR CARLOS MONTEIRO, PROFESSOR OF NUTRITION AND PUBLIC HEALTH 3


4

CARBOHYDRATES Dietary guidelines advise people to choose higher fibre, wholegrain

varieties of carbohydrates, but those most commonly consumed by children in England are refined, low-fibre cereals such as white pasta, white rice, white bread and pizza, and potatoes, which have typically been roasted or fried as chips and crisps.10

Pasta, rice, pizza, chips and white bread together provide 23% of the total energy intake for children aged four to 10 years, compared to 8% from brown bread, high fibre breakfast cereals and non-fried potatoes.11

Children don’t need as much fibre in their diet as adults, but they need more than they currently get. Children aged five to 16 in England are only consuming 15 grams or less of fibre each day, when they should be consuming 20 to 25 grams.12

PROTEINS One third of the meat that children eat is processed in the form of

sausages, kebabs, burgers, pies, and coated chicken.14 43% of children aged 11 to 18 years eat more than the recommended amount of red and processed meat.15

Milk and cheese consumption has fallen in recent years, but there has been a significant increase in yoghurt consumption. Natural yoghurt can be good for gut health,16 but most yoghurts eaten by children are high in sugar. Yoghurt is now one of the highest sources of sugar in children’s diets.17

Fewer than one in 10 children eat enough fish to meet dietary guidelines. Children are consuming less oily fish than they used to and more coated and fried fish, such as fish fingers.18

Dietary guidelines suggest that children should eat more pulses, beans, peas and lentils as alternatives to meat because they are naturally high in fibre, protein, vitamins and minerals. Children currently eat an average of 11 grams of pulses a day, but these are mainly in the form of baked beans.19

THE CONSEQUENCES The UK is the most obese country in Western Europe,

with levels of obesity growing faster than in the US.20

One in 10 children in England is obese before they start school. One in five children is obese by the time they leave school.21

170 children in England have multiple teeth removed in hospitals every day – this number is at a record high.22

The number of children with Type 2 diabetes caused by poor diet has soared 41 per cent in just three years.23

Poor diet has overtaken smoking as the leading risk factor for poor health.24

Girls born in England have the second lowest life expectancy in Europe. They can expect to live a shorter life than girls born in Spain, France, Italy, Portugal, Sweden, Germany, the Netherlands and Greece.25

CHILDREN DON’T NEED AS MUCH FIBRE IN THEIR DIET AS ADULTS, BUT THEY NEED MORE THAN THEY CURRENTLY GET.

FEWER THAN

children eat enough fish to meet dietary gudelines.18

I have to work hard to counteract the marketing of junk food to my kids. Through TV and public advertising, sports and events. It takes considerable time and energy to explain why it is that they are not allowed these foods. 13

MOTHER OF CHILDREN AGED 7 AND 9

We know that takeaway foods can be really unhealthy. Around our school there is much unhealthy food, including a fish and chip shop and other takeaways. These places do ‘buy one get one free’ offers to make you buy more than you need.

ISMAEEL AND HAMMAD, 12


B. HAS 2018 BEEN A GOOD YEAR FOR CHILDREN’S FOOD?

INFANT NUTRITION, INCLUDING BREASTFEEDING – research published in 2018 showed that the UK has one of the lowest breastfeeding rates in the world, with just 34% of babies receiving any breast milk at six months, compared with 62% in Sweden.

FOOD IN THE EARLY YEARS – the Government’s 30 hours free childcare policy has pushed a rising number of early years settings over the edge, with thousands closing their doors and many discontinuing their lunch provision.

FAMILY FOOD INSECURITY – Government statistics show that 4.1 million children are now living in relative poverty, an increase of 100,000 on last year, accounting for more than 30% of children in the country.

POLITICAL AMBITION ON CHILDHOOD OBESITY – the latest chapter of the Obesity Plan sets the target of halving rates of childhood obesity in England by 2030, demonstrating high levels of ambition that must now be matched with action.

RESTRICTING JUNK FOOD ADVERTISEMENTS – the Government will consult on introducing a 9pm watershed on TV advertising of unhealthy products and similar protection for children viewing adverts online.

‘OPERATION EAGLE EYE’ – coordinated by the Children’s Food Campaign at Sustain, Operation Eagle Eye has successfully brought complaints to the Advertising Standards Agency for irresponsible ads targeted at children by food companies.

RESTRICTING UNHEALTHY PROMOTIONS – the Government intends to ban price promotions, such as ‘BOGOF’ and unlimited refills of unhealthy foods and drinks, and to restrict the positioning of unhealthy foods and drinks in shops.

TACKLING JUNK FOOD IN LONDON – the draft London Food Strategy proposes to ban junk food advertisements on the Transport for London estate, setting a precedent for bolder national action on junk food ads.

FISCAL INCENTIVES FOR HEALTHIER DRINKS – the ‘Sugar Tax’ has encouraged reformulation: many drinks have been reduced in sugar, but they are now high in sweeteners – are artificially sweetened drinks really the answer?

GREEN FLAG = Moving forward

AMBER FLAG = In the balance

RED FLAG = Going backwards

CHILDREN’S FOOD IN RESTAURANTS AND ATTRACTIONS – Food for Life’s Out to Lunch campaign has shown that children’s menus are progressively improving, but many are still lacking in veg and processed meat continues to dominate.

‘PEAS PLEASE’ – led by the Food Foundation, Peas Please has generated an array of commitments from businesses to increasing veg consumption, including among children. Asda, Aldi and Waitrose are the latest to pledge their support.

SCHOOL FRINGE – the Mayor’s draft London Plan proposes to ban takeaways from opening within 400 metres of schools in the capital, but there were no similar new powers for local authorities in the national Obesity Plan.

HEALTHY RATING SCHEME FOR PRIMARY SCHOOLS – promised more than two years ago, will the Healthy Rating Scheme ever be developed? Will it be ambitious and support schools to adopt a ‘whole school approach’ to good food?

SCHOOL FOOD STANDARDS – the Government promised to update the Standards to account for new recommendations on sugar and carbohydrates. It also promised to encourage all schools to comply. We’re still waiting on both counts.

QUALITY OF SCHOOL MEALS – after years of positive advances in the quality of school meals, we now face a return to the dark days of the Turkey Twizzler. A perfect storm of challenges means many caterers are being pushed to the brink.

PRIORITISATION OF FRESH AND MINIMALLY PROCESSED FOODS – efforts to improve children’s food remain too focussed on reformulation and insufficiently upon encouraging children to enjoy real, fresh food, eaten around a table together.

A HEALTHY FOOD BREXIT? – government has failed to guarantee legal protections for food standards in trade deals and future food and farming policy is yet to be determined. Brexit hangs in the balance.


STATE OF THE NATION: CHILDREN’S FOOD IN ENGLAND, 2018 | 11

* The NOVA classification system groups foods according to the nature, extent and purpose of the industrial processing they undergo. Under NOVA, foods are classified as ‘unprocessed or minimally processed’ (such as fruit and veg, milk and eggs, cuts of meat), ‘processed culinary ingredients’ (such as oils, butter, sugar and salt), ‘processed’ (such as bottled vegetables, canned fish, fruits in syrup, cheeses and freshly made breads) and ‘ultra-processed’ (such as ice-cream, sweets, mass produced breads, sausages and burgers).

WHAT IS ULTRA-PROCESSED FOOD? *

Ultra-processed foods are ‘industrial formulations’ manufactured with the use of substances not normally found in kitchens. Examples include soft drinks, sweet or savoury packaged snacks, and reconstituted meat products.

INTRODUCTION

In 2018, children’s food in England is at a cross-roads. The Government has announced a raft of new measures to support children to enjoy a better diet, but many of these are contingent upon further consultation. The UK’s departure from the European Union bares down upon us, but the implications for the way that we eat remain uncertain. Will Brexit prove to be a boon or a burden for children’s food? Will 2018 be remembered as the year that we finally turned the tide on childhood obesity, or the year where we sank further into collective ill-health? One thing is clear: much is at stake.

This report looks backwards in order to look forwards. It provides an overview of how children have eaten in 2018, considering the political, environmental and social forces that have shaped their diets, to arrive at recommendations for government action: five proposals with the potential to improve children’s food in England in 2019 and beyond. Throughout the report, a diverse range of issues and perspectives are considered – we hear from children, parents, cooks and teachers – but there is one unifying theme: the need to turn the tide against the rise of ultra-processed rubbish.

In 2017 it was revealed that the UK is the undisputed junk food capital of Europe. UK families consume more ultra-processed foods than families in any other European country.26 From biscuits to fizzy pop, breakfast cereal to baked beans, ultra-processed foods make up 50.7% of our national diet. This figure is striking when compared to our neighbours: ultra-processed foods make up a mere 14.2% of family food purchases in France and 13.4% of purchases in Italy.27

You might ask: So, what? What’s the beef with processed foods? Isn’t this talk of ‘ultra-processed’ food alarmist? And isn’t this a middle-class concern, “a bunfight over privilege”, as one journalist recently described it?28

We don’t think so. For one thing, the issue isn’t the processing of food per se. Most of the foods we eat have been processed in some form, whether by being chopped, peeled, frozen, boiled or baked. Ultra-processed foods are different. They are understood as “industrial formulations manufactured almost entirely from sugar, salt, fats and oils, starches and many substances derived from foods but not normally used in kitchens, and additives used to imitate the sensory qualities of natural foods or disguise undesirable qualities of the final product”. They are ‘food’ masquerading as food, manufactured to be durable, hyper-palatable, habit-forming and profitable.

And here’s the nub; researchers have identified “a significant positive association” between the proliferation of ultra-processed foods in the national diet and the prevalence of obesity and dietary ill-health. Each percentage increase in the household availability of ultra-processed foods at a national level is associated with a 0.25 percentage increase in the prevalence of obesity. The higher the proportion of ultra-processed foods in the national diet, the higher the risk of diet-related non-communicable diseases.29

Seen in this light, the disparity between our diet and that of our neighbours becomes more concerning, particularly when the consequences for child health are considered. Whereas 20% of children aged 10 to 11 in England are obese, in France, where ultra-processed foods comprise a far smaller proportion of the diet, fewer than 10% are.30

In one sense, both the challenge and the solution are straightforward: “Diets that include a lot of ultra-processed foods are intrinsically nutritionally unbalanced and intrinsically harmful to health,” says Dr Carlos Monteiro, Professor of Nutrition and Public Health at the University of Sao Paulo, who led the research comparing European diets. “The best dietary advice is to base diets on fresh and minimally processed foods.” 31

INTRODUCTION

Despite obesity being in the political spotlight this year, we have a long way to go until children in England enjoy such a diet. Arguably, the Government’s approach to children’s food and childhood obesity remains too narrowly focussed on

the reformulation of ultra-processed foods to reduce calories and sugar. We do not see evidence of the leadership needed to ‘put food back into food’ and support a shift towards healthier diets based on a diverse range of nutrient-rich, minimally processed foods.

Public Health England is leading the charge with a calorie reduction programme that aims to remove calories from popular children’s foods, including pizza, biscuits, buns, cakes, pastries, breakfast cereals and meat products. If successful, such reformulation will clearly contribute towards tackling obesity. By itself, however, it will do little to tackle empty calories and improve the quality of our children’s diets. Food manufacturers should not be given license to use ’reduced calorie’ claims on processed foods to give the impression that these are healthy options. Paradoxically, the fresh, minimally processed food we should be feeding our children is less packaged and less easily badged with health claims.

The Soft Drinks Industry Levy provides a case in point. Launched in April, the Levy has successfully prompted drinks manufacturers to reformulate their products. Sugar is out. Artificial sweeteners are in. Drinks manufacturers are promoting reformulated drinks as the ‘healthier’ alternatives and sales are on the rise.32 Cutting sugar from children’s diets is undoubtedly a good thing, but the long-term consequences of a diet high in artificial sweeteners are uncertain. This is not necessarily because of any purported safety issues, but because sweeteners shape children’s preferences and behaviours in the long run,33 and because a growing body of evidence is revealing that they interact harmfully with the gut microbiome.

The gut microbiome is home to the 100 trillion or so micro-organisms with whom we live in symbiotic relationship. Research published in the British

Medical Journal this year found that sweeteners such as sucralose, aspartame and saccharin, along with the chemicals and food additives commonly found in ultra-processed foods, reduce the health and diversity of the microbiome.34

A diverse and abundant gut microbiome is associated not only with a reduced risk of obesity and type-2 diabetes,35 but with improved emotional and mental health outcomes.36 A junk food diet, on the other hand, is understood to heighten the risk of depression.37 This suggests that a diet rich in ultra-processed foods can be harmful, even if these foods have been reformulated under the watchful eye of Public Health England to include fewer calories.

In the diet as in the gut, diversity is the cornerstone of health. With ultra-processed foods made predominantly of just four ingredients – corn, soy, wheat and meat38 – a diet dominated by such foods can never be truly healthy. Along with analysis and discussion, this report includes recommendations for government action: five proposals with the potential to improve children’s food in England. These proposals are targeted squarely at increasing the proportion and diversity of fresh and minimally processed foods in children’s diets. It’s time to ditch the junk and rediscover the joy of real food, eaten around a table together.

THE GUT MICROBIOME

Home to the 100 trillion or so micro-organisms.

10 | www.foodforlife.org.uk


RECOMMENDATION #1: Fix the School Fruit and Veg Scheme. The Government should re-specify the scheme so that a higher proportion of the produce is British, local and organic, and is therefore fresher, of known provenance, lower in pesticide residues and more enjoyable for children.

All children aged four to six attending a state-funded school in England are entitled to receive a free piece of fruit or veg each school day through the School Fruit and Veg Scheme. This £40 million scheme represents an important investment in child health and is widely supported by teachers: a Food for Life teacher survey conducted in 2018 revealed that 92% of teachers think the scheme has the potential to increase children’s fruit and veg consumption.39 But the teachers who responded to the survey were highly critical of the quality of the produce provided. They described it as lacking in freshness, far from tasty, and frequently inedible. There is consequently a high level of waste.

“Pears are under-ripe and hard, carrots have been sweating in bags for days. Generally, the produce is not as fresh as we would hope, and this means the

children don’t eat it,” one teacher told us.

Part of the issue is the length and complexity of supply chains. A relatively small percentage of the produce provided through the scheme is British.

In response to a Freedom of Information Request, the Department for Health and Social Care conceded that only 13% of apples and 5% of pears are sourced

from this country. And there’s more. Government data also shows that the produce supplied through the scheme contains higher pesticide residues than equivalent produce found on supermarket shelves, including pesticides associated with a negative effect upon children’s cognitive development.40

As any parent knows, getting children to eat their greens can be a struggle. The School Fruit and Veg Scheme provides a golden opportunity to diversify children’s tastes and instil a love of fresh produce from a young age – but it’s an opportunity that’s being squandered. There is a risk that children are being taught instead that fresh fruit and veg lacks flavour or texture and is only fit for the bin.

Re-specifying the scheme so that a higher percentage of the produce is LEAF or organic and is freshly harvested from more local supply chains would ensure that more appealing and tastier fruit and veg, with lower pesticide levels, would arrive in schools. Teachers say that this would lead to increased consumption by children. It would also benefit British farmers and growers.

This is a timely moment to re-specify the scheme. As the UK’s departure from the European Union approaches, the Government is developing food and agriculture strategies that will aim to promote healthier eating while providing more secure markets for British farmers. A re-invigorated School Fruit and Veg Scheme provides the opportunity to further both these ambitions at once.

Research published this year by the Royal Society for Paediatrics and Child Health revealed that the UK has one of the lowest breastfeeding rates in the world, with only 34% of babies receiving any breast milk at six months, compared with 62% in Sweden.46

This is despite the “overwhelming evidence” that breastfeeding provides health benefits that extend throughout infancy, the early years and beyond.47 Breastfeeding is known to protect against infections and to provide notable health benefits to the mother, yet less than half of mothers in England (43%) are breastfeeding their babies at two months after birth.48

Inequalities in diet and health are present from the very beginning of life. The 2018 Health Profile for England found that “children who live in more deprived areas were more likely to be exposed to avoidable risks before birth, to get off to a less healthy start from birth and to experience poor outcomes by the time they start school, compared with children who live in less deprived areas.”

These inequalities are aggravated by inefficiencies in welfare provision, including in the Healthy Start scheme. The scheme provides parents with young children on a low-income with vouchers for milk, fruit and vegetables or infant formula, and coupons for vitamin supplements, but analysis from First Steps Nutrition Trust shows that uptake of the scheme has declined in recent years and the value of the voucher has fallen out of step with rising food prices. Healthy Start vouchers are no longer sufficient to provide adequate nutritional support to families, either in the form of infant formula or the five portions of a variety of fruit and vegetables that pregnant women and children aged one to four should be consuming each day.49

THE UK HAS ONE OF THE LOWEST BREASTFEEDING RATES IN THE WORLD, WITH JUST

of babies receiving any breast milk at six months, compared with

in Sweden.41

CONSUME, ON AVERAGE, MORE THAN DOUBLE THE AMOUNT OF SUGAR THAT IS RECOMMENDED42

children in England has tooth decay by the time they start school.43

CHILDREN LIVE IN RELATIVE POVERTY.44

OF EARLY YEARS SETTINGS FEAR CLOSURE IN THE NEXT 12 MONTHS, with many discontinuing any form of food provision in an effort to make ends meet.45

CHILDREN’S FOOD IN THE EARLY YEARS


These inequalities face further aggravation by the challenged state of food provision in early years settings, including nurseries and childcare centres. The early years sector is facing severe funding difficulties, associated with the introduction of the Government’s free childcare policy, launched in 2017, which entitles the parents of three and four year olds to 30 hours of free childcare during term time. Many believe the policy to be chronically underfunded, and settings are being forced to take drastic measures to make up for the funding shortfall, often with negative consequences for food provision.

Ofsted figures show that between 2015 and the beginning of 2018, over 1,000 early years settings were forced to close due to lack of funds.50 A survey published in September of this year found that four in 10 early years settings are concerned they will be forced to close in the next 12 months. Four in 10 have also introduced or increased charges for additional goods and services, including food, to make up for the funding shortfall.

Only months after the policy had been implemented, stories began to emerge of early years settings being forced to charge parents a higher cost for lunch. One setting began charging £15 per meal to make up for the gap in funds.51 Parents at this setting were told that they would have to take their child home at lunchtime if they didn’t want to pay. “It’s unethical and totally unfair but I don’t have a choice,” the setting manager said.52

It’s clear from such examples that the policy is failing to benefit many parents. Those settings that are managing to make the 30 hours work are often only able to do so by introducing or increasing additional fees and charges, including for food.

Other settings are discontinuing their meal service and are requesting that parents provide both snacks and a packed lunch each day.53 As is the case in schools, most parents struggle to provide children at early years settings with packed lunches across the course of a week that are as nutritionally diverse and as healthy as hot meals.

In failing to provide adequate funding for the 30 hours free childcare policy, the Government is heightening the risk that many children in the early years are failing to enjoy an adequate diet, entrenching the inequalities in diet and health that are present from birth. When Universal Infant Free School Meals were introduced for school children in Key Stage 1, it was on the premise that universal provision would help alleviate inequalities in health and attainment – these very inequalities are being needlessly accentuated by the poor state of food provision in early years settings.

The Government must now commit to ensuring good food in the early years: hot meals, adequately funded, freshly prepared and available to those that need them most.

I’ve seen first-hand how good food in the early years can benefit a child’s health and enhance their learning. This is such a crucial stage in their lives – not only are their cognitive and social skills developing, so are their eating habits and food preferences. Children in the early years flourish, both personally and educationally,when they have the opportunity to engage with real food and to eat a healthy hot lunch.

This is why the Government’s free childcare policy is such a cause of concern for some in the early years sector. Can early years settings make ends meet, balancing the requirement to provide more free childcare on the allocated budget with the cost of providing healthy hot lunches? Will settings be forced to accept unhealthy packed lunches, or will they have to charge extra to parents? These are some of the questions the sector is grappling with, and in many cases there is no easy answer.

What matters now is that settings are supported to implement the policy in a way that does not compromise the quality of the food they serve. The Government should ensure that early years settings are properly funded to provide both good care and quality food for all children taking up the 30 hours offer. Otherwise, this policy will represent a huge missed opportunity.

JO INGLEBY IS A SCHOOL COOK WHO WAS AWARDED COOK OF THE YEAR AT THE BBC FOOD AND FARMING AWARDS FOR HER WORK IN THE EARLY YEARS SECTOR



RECOMMENDATION #2: Invest in food in the early years. The Government should urgently review its 30 hours free childcare policy and ensure that early years settings are adequately funded to provide food. Free healthy lunches should be provided for the most disadvantaged children as part of their entitlement, in line with entitlement for free school meals.

The hidden impact of the 30 hours childcare policy on food in the early years sector is fast becoming a national scandal. By failing to invest adequately in the policy and in food provision, the Government is forcing many settings into closure, while others are discontinuing their hot meals service, fuelling inequalities in diet and health.

The lack of adequate funding for food in early years settings also represents a huge inconsistency in approach, when compared to primary school funding for school meals.

The Universal Infant Free School Meal policy was introduced on the basis of evidence that it would benefit all children’s health, development and attainment, but particularly those children most in need.

The same benefits are being denied to children in the early years, putting many children at a disadvantage before they even receive Universal Infant Free School Meals.

The Government must ensure that early years settings are properly funded to provide good care and quality food for all children taking up the 30 hours funded childcare offer. As part of this funding, the Government should, as a minimum, commit to free healthy lunches for the most disadvantaged children as part of their childcare entitlement, in line with entitlement for free school meals.

Our Children’s Centres have been working with Food for Life since 2015 and received our first Food for Life Early Years Award at Innovation’s Children’s Centre in 2016. I am not overstating things to say that working with Food for Life has been life-changing for our children’s centres. From the food we prepare to the education we provide – food is now at the centre of our children’s experience. Most importantly, it’s provided us with a playful way to involve parents and the wider community in the work that we do.

As a staff group, we’re now convinced of the central role of food in the work that we do. Many of our children receive 100% of their calories and nutrition each day at nursery, so transforming our food offer to make sure that it’s freshly prepared, traceable and gives our children a full experience of flavour and texture has been a key part of the process. It hasn’t all been plain sailing – convincing children, and parents, to try new foods and to communicate the value of what we’re doing in a way that doesn’t come across as judgemental, or preachy, has been challenging. But there have also been many moments that remind us why we’re doing what we’re doing – seeing parent’s reactions to chocolate beetroot cake, knowing that our cook is immensely proud of what she produces every day, providing tasty meals that keep our staff well fed as well as our children.

We’re proud of everything we’ve achieved – but more than anything, knowing that we can send our children – many of whom have set-off into life with disadvantages, in terms of the employment and education of the people around them, and in terms of financial stability – into primary school with healthy appetites for good food, ready to listen, learn and eat well – nothing makes us more proud than that.

KIRALEA WHITEHEAD IS CHILDREN’S CENTRE MANAGER FOR THE NORTH HALIFAX PARTNERSHIP TRUST

In the early 2000s, school food was in a dire state. Menus were dominated by low cost, low-quality junk, including the notorious ‘Turkey Twizzler’; a

snapshot survey in 2003 found that “the majority of school menus offer children a low-grade diet of dematerialised fish, mechanically recovered meat and poor-quality produce containing pesticide residues.” Local authority caterers were spending, on average, only 35 pence per child a day on school lunch ingredients.57

The tide began to turn in 2003 when pioneering dinner lady Jeanette Orrey teamed up with the Soil Association to launch the ‘Food for Life’ campaign. A success story for school food unfolded across the following decade: Jamie Oliver joined the battle for better school meals, mandatory nutrition standards were agreed, Food for Life grew into a national programme, and the publication of the School Food Plan in 2013 saw the introduction of Universal Infant

Free School Meals. Today, more children than ever before are enjoying a healthier and higher quality school meal with more than 10,000 schools serving Food for Life-certified menus. But all that is now under threat. School food faces unprecedented challenges – the dark days of the Turkey Twizzler might be set for a return.

Throughout 2018, Food for Life has interviewed cooks, caterers and other stakeholders to understand the status of school food in England. These interviews have revealed not only the enduring commitment of cooks and caterers to delivering a high-quality service, but a cocktail of pressures and challenges that threaten to make this impossible, creating a new ‘race to the bottom’, undermining the advances of the last decade. Due to commercial sensitivities, the discussion that follows has been anonymised.

CHILDREN’S FOOD IN SCHOOLS

PARENTS SAVE

and around 50 minutes a week by not having to make packed lunches for children receiving Universal Infant Free School Meals.54

THE COST OF FRESH FRUIT AND VEGETABLES sourced by school caterers rose by up to

throughout 2018.

OFSTED’S 2018 THEMATIC REVIEW REPORTS THAT ONLY

of primary schools are implementing the requirements of the National Curriculum to deliver practical cookery education.55

IT’S BEEN 24 MONTHS AND COUNTING SINCE THE GOVERNMENT COMMITTED TO A HEALTHY RATING SCHEME FOR PRIMARY SCHOOLS – the Scheme is yet to see the light of day.

CHILDREN IN FOOD FOR LIFE SCHOOLS ARE TWICE AS LIKELY TO EAT THEIR

compared to children in matched comparison schools.56



Part of the challenge relates to rising ingredient costs and overheads. Caterers reported that the costs of some fresh fruits and vegetables had risen by up to 20% throughout 2018. Staples such as pasta, cheese and yoghurt had also risen steeply; one caterer reported that eggs were up 14%. These rising costs were believed to be partly due to uncertainty over Brexit and future trade arrangements, with caterers also concerned that a ‘No Deal’ Brexit might further increase prices. On top of this, caterers have had to handle the introduction of the Living Wage, the Apprenticeship Levy, and rising pension contributions. One local authority caterer is facing an increase in staff costs of £330,000 this year due to the introduction of the Living Wage.

All the caterers that we spoke with were working hard to maintain the quality of school meals, tweaking menus and buying in more cost-efficient ways, but for many the numbers don’t add up.

Cold ‘pick and mix’ lunchbox options are being introduced instead of hot meals. “2018 will be the

tipping point for school meals,” one caterer told us. “Pressure is mounting on expenditure and cold meals will be the result.” Healthier items such as fresh fruit and salmon are being removed from menus in favour of more affordable but less healthy items such as puddings and biscuits.

Menus are not only including fewer healthy items, caterers are being forced to source lower quality ingredients. One caterer explained that tens of thousands of pounds would be saved by switching from a locally sourced cheese to a lower quality alternative sourced from abroad – this just when British farmers are concerned about Brexit and the Government is talking up the potential of public procurement to support British markets.

At a time when leadership from public sector procurement is so urgently needed, caterers are reporting that procurers are abandoning their commitment to quality and nutrition in favour of least cost solutions. The relative weightings given to price and quality in school catering tenders have a big impact on the quality of food provision; in recent years, as local authorities seek to make challenging budget cuts, there has been a shift towards tenders giving a higher weighting to price relative to quality, effectively ensuring that the cheapest bid wins. “We won’t go for contracts that are less than 50-50, in terms of the cost to quality ratio,” one caterer explained, “but we’ve recently seen a ratio of 80-20.” This focus on price over quality is a slippery slope for school meals.

The School Food Plan highlighted the “virtuous circle” that can result when caterers serve higher quality meals; more appealing meals can result in a higher uptake, meaning more money going into the meal service, supporting caterers to source higher quality ingredients and to make meals available at an affordable price. Prioritising cost over quality could mean more children choose to eat a packed lunch.

Ofsted surveyed the contents of school packed lunches as part of their thematic review of healthy eating in primary schools, published in July, and found that a typical packed lunch included a packet of crisps, a pot of yoghurt and a ham sandwich. Ofsted said, “We saw no strong evidence in our research to suggest that packed lunches are playing a significant role in the obesity crisis.”

But Ofsted’s findings should be of concern. At issue is not simply that yoghurt is one of the highest sources of sugar in children’s diets58 or that 43% of children eat more than the recommended amount of red and processed meat,59 or that the packed lunches that Ofsted surveyed were also found to commonly include cakes, chocolate bars and biscuits. It’s that this snapshot of ultra-processed foods in packed lunches is representative of the prevalence of ultra-processed foods in children’s diets more broadly.

ONLY

of school packed lunches meet the nutritional requirements of the School Food Standards.60

This is often not due to a lack of care or concern from parents, but because the Standards have been deliberately devised to ensure dietary diversity. This diversity is almost impossible to replicate in a packed lunch, unless one is cooking from scratch each day using fresh ingredients.

The caterers we interviewed also raised a question mark over the spend of school meal budgets, including the £2.30 allocated to each meal served under Universal Infant Free School Meals. Some caterers were quietly concerned that local authorities might be ‘siphoning’ off funds for school meals to plug black holes in their budgets elsewhere. Local authorities have faced challenging cuts in recent years and the budget for school meals isn’t ringfenced.

Caterers are being asked to deliver meals at a lower cost, despite rising ingredient prices, and there is little or no oversight from Government of how the £2.30 is spent.

Among the caterers who expressed concern was one who said that they already paid ‘central charges’ to the local authority, covering payroll and procurement, of over £1 million per year, but this was increasing by £200,000 this year alone.

They said they had not been given an adequate explanation as to what these additional charges were for. In parallel, spend on ingredients was being cut, even as ingredient costs were rising. The only way they could make ends meet was to source lower quality produce.

The backdrop to this picture is one of political inertia. Food for Life estimates that up to 60% of secondary schools are non-compliant with the School Food Standards, largely because of an absence of

government monitoring. Most of the actions related to school food in the 2016 Obesity Plan remain outstanding: the Government is yet to launch the Healthy Rating Scheme for primary schools that was promised; it is yet to update the School Food Standards to reflect the latest dietary guidelines. School food, it seems, is simply not a political priority.

It should be. After more than a decade of advances in the quality of school meals – advances won by the dedication of many head teachers, chefs, cooks, local authorities and caterers – the Turkey Twizzler might yet return to rear its unappetising head. Children spend 190 days in school each year, and for many a hot school lunch is their only hot meal of the day. The cheap, processed low-quality meals that were doled out to children in the early 2000s have been relegated to history, and there they must stay. The Government must now take steps to safeguard the quality of school meals and ensure the new ‘race to the bottom’ does not materialise.

I never thought that 15 years after the Food for Life school meals report was published that we would be facing similar challenges, or that we would be asking the same questions in 2018.

Back in 2003 we argued that school meals should not be contributing to ill-health, social problems at school, environmental degradation, animal suffering, or the decline of rural economies. We said that by serving fresher and more minimally processed foods, sourced locally and grown organically, we could improve children’s nutrition, support local economies, and create a healthier environment. Much of this has been achieved through the hard work and dedication of the school meals catering service and other campaigning organisations.

But in 2018 school meals face extraordinary challenges. Food costs are increasing and schools are having to look at where they can reduce costs – school food is vulnerable, as no one is overseeing the budgets. Nowhere does it stipulate that schools have to serve a hot meal, and there has been no increase in the £2.30 for UIFSM since its implementation, even though food costs have risen.

There has never, after reading this report, been a stronger set of reasons for the Government to make decisive, far-reaching and cross-cutting intervention to protect school meal budgets and upgrade school meal provision. What we’ve achieved since 2003 cannot be allowed to be lost.

JEANETTE ORREY MBE IS A FORMER SCHOOL DINNER LADY AND CO-FOUNDER OF FOOD FOR LIFE.



RECOMMENDATION #3: Safeguard the quality of school meals. The Government should take steps to avoid a new ‘race to the bottom’ in school meals by ringfencing Universal Infant Free School Meal budgets and giving clear guidance to procurers that quality should always be given greater weighting than cost.

There are many actions that the Government should take to safeguard the quality of school meals and improve food in schools. The Government should require procurement decisions for school meals to place a weighting of at least 60% on quality relative to cost. It should implement the commitments made in the 2016 Obesity Plan. But first and foremost, the Government must ensure that funding for school meals is spent on school meals – this means ringfencing the budget for Universal Infant Free School Meals and providing greater oversight over its spend.

The Government should also commit to the policy in the long-run. Many caterers’ business models are dependent upon Universal Infant Free School Meals. Discontinuation of the policy, as the Conservatives threatened during the 2017 General Election, would result in financial difficulties that would drive down the quality of meals and render some services unviable. One caterer stated the issue in stark terms: “If we lose Universal Infant Free School Meals, the industry dies with it.”

The Government should commit to continuing Universal Infant Free School Meals and to reviewing the funding allocation to ensure that it is properly funded for all schools. As a first step, it should ringfence the £2.30 allocation and support schools and local authorities to provide greater oversight over how this money is spent.

School catering has always been a juggling act! Not only working within tight budgets and ever-changing policies but also continuing to be innovative and keep up with the trends to ensure meal uptake is high. I work with multiple schools across Devon and have found that all the school cooks I work with have embraced this year’s changes and challenges and are as flexible and adaptable as ever – most importantly they have the child as their focus and are trying hard to give the best nutritional value on the plate.

Recent rises in food prices and other costs have meant that we all have had to get clever with our ingredients, introducing new dishes with cheaper cuts of meat and adding meat free days. Being a Food for Life school with the gold School Award we have always had close relationships with our suppliers who work with us providing the best prices they can as they understand what we are trying to achieve for our children. We continually strive to support local suppliers and use seasonal produce to get the best prices. But for many caterers, the current environment is tremendously challenging.

SAM WARD IS SCHOOL COOK AT COLLATON ST MARY PRIMARY SCHOOL AND WAS THE WINNER OF THE 2014 PRIMARY SCHOOL CATERER OF THE YEAR PRIZE

In the two years since the first chapter of the Government’s Obesity Plan was published, it is disappointing and disheartening that the commitments made regarding schools’ impact on healthy eating habits have not been followed through. The opportunity to highlight and celebrate a ‘whole school approach’, and the benefits it can have on continued health education for children, has not been taken up with the roll out of the Healthy Rating Scheme. This was due for implementation in September 2017 but has failed to materialise.

The introduction of this scheme for primary schools would have provided momentum for all schools to begin to adopt a ‘whole school approach’ to supporting children’s health and well-being in the curriculum. It could have been a positive step towards addressing the childhood obesity issues we have in this country. With the failure to implement this measurable approach, the Government has failed to begin a process that could have made a significant impact on the health of our nation. This failure has meant that there continues to be very little reference to the importance of healthy eating in Ofsted’s School Inspection handbook and inspectors’ evidence base for comments is a cursory stroll through the dining hall at lunchtime and brief non-evidence-based comments with children.Work also needs to be done on updating the School Food Standards to ensure that all academies and free schools, who receive public funding, are following the guidelines in the School Food Plan.

JASON O’ROURKE IS HEADTEACHER OF WASHINGBOROUGH ACADEMY AND WAS WINNER OF THE EDUCATERING SCHOOL FOOD PLAN AWARD IN 2016”

“““



For many children, from the moment they wake up in the morning, the odds are stacked against them. They glance at their phone and junk food adverts gaze back. They walk to school and pass convenience stores garbed with garish banners promoting the latest energy drink. At lunchtime, they step out of the school gates and there are half a dozen fast food takeaways within five minutes’ walk. In the evening, as they sit and watch the television, a stream of adverts promotes restaurant menus and supermarket products, each more ultra-processed and unhealthy than the last.

For parents, this can add up to considerable strife. “My son is out of control when it comes to junk food,” one woman, who has a six year old son, said, speaking to charity Sustain. “There is junk food marketed and promoted almost everywhere we go. It has robbed me of the joy of bringing up my son,

and is causing a great deal of stress, as well as health problems for my son. My son has tantrums if he can’t have the junk food being marketed and promoted to him. I have been bitten, hit and scratched by my son in his battle to get me to cave in to what he craves.” 66

In July the Government took steps to protect children and families from junk food adverts. The Obesity Plan promised a consultation on the introduction of a 9pm watershed on television adverts for junk food targeted at children, and similar protection for children viewing adverts online. It also promised a consultation on a ban on price promotions, such as ‘buy-one-get-one-free’ and multi-buy offers or unlimited refills of unhealthy foods and drinks in the retail and out of home sectors, and a ban the promotion of unhealthy food and drink at retail checkouts. Not before time.

CHILDREN’S FOOD OUT AND ABOUT

93%OF PARENTS SAY THEY ARE CONCERNED ABOUT THE EFFECT OF JUNK FOOD MARKETING ON THEIR CHILDREN, WITH

56% describing themselves as extremely concerned.61

OF PARENTS EAT OUT WITH THEIR CHILDREN AT LEAST ONCE A FORTNIGHT, BUT

of parents say they don’t think children’s food in high street restaurants is good enough.62

CHILDREN

13%of their calories eating out,

4% THEIR VEG63

OF THE UK’S TAKEAWAYS ARE LOCATED WITHIN A FIVE-MINUTE WALK OF A SCHOOL.64

CHILDREN FROM THE MOST DEPRIVED AREAS ARE

TO BE OBESE compared to children from the least deprived.65

OUT TO LUNCH – BEST CHILDREN’S MENUSRESTAURANT CHAINS1. JAMIE’S ITALIAN2. WETHERSPOONS3. STRADA4. WAHACA5. BEEFEATER

VISITOR ATTRACTIONS1. ROYAL BOTANIC GARDEN EDINBURGH2. EDEN PROJECT3. CHESTER ZOO4. WHIPSNADE ZOO5. SCIENCE MUSEUM

The draft London Food Strategy, published in July, went one further, proposing to ban junk food adverts from appearing anywhere on the Transport for London estate. This is not the only area where London is a step ahead of the national curve. The Mayor’s draft London Plan also proposed to ban new takeaways from opening within 400 metres of schools – a commitment that was notably absent from the Government’s Obesity Plan.

The number of takeaway outlets in England has risen sharply in recent years, and particularly in areas of greater deprivation. There are five times as many fast food takeaways in the most deprived areas of England compared to the least deprived areas. Children from lower socio-economic groups consume these takeaways more frequently than other children.67

The consumption of takeaways is particularly popular among families. A recent survey found that 68% of households with children under 16 had eaten takeaways in the last month, compared with only 49% of adult-only households.68

Families are also eating out more often. One in five family meals is now eaten outside the home, meaning children today are eating out twice as often as previous generations.69

Children are often offered a raw deal when eating out. Food for Life’s Out to Lunch campaign has been investigating the food served to children and families outside the home since 2013. This year the campaign surveyed the food at leading visitor attractions and found that adult food options were typically healthier and higher quality than children’s food options. At the National Gallery, most children’s meals weren’t served with any veg, even though there were more than a dozen different vegetables used on the adult menu. Of the 22 attractions surveyed, only three ensured that there was a portion of salad or veg in every child’s lunchbox.

Legoland, which scored in joint-last position in the league table, provides a telling case study of the pitfalls that families face when eating out. Legoland, owned by Merlin, is the most popular theme park in England, welcoming over two million visitors every year. From the moment children step through the gates, they are met with unhealthy food options and junk food advertisements. Coca-Cola is advertised at child-height and there are drinks on offer that include 61 grams of sugar per portion, more than twice the recommended daily sugar intake of an

adult and triple that of a child. The ‘all inclusive’ entrance ticket provides children with refillable fizzy drinks throughout the day and lunch at one of two restaurants, both of which offer burgers, fried chicken and chips, but neither of which provide children with any veg, even though veg is available on the adult menu.

Eating in Legoland is by no means an everyday event for families, but as an iconic attraction it could be setting a more positive example, instead of denying children healthy choices and using promotional deals to push junk food on families.

In Legoland’s defence, from one point of view, its commitment to ‘healthier’ children’s food is exemplary. Refillable fizzy drinks might be available throughout the site, but all the drinks were recently switched to zero-sugar, artificially sweetened versions. Fresh fruit might be difficult to find, but the myriad shacks selling ice creams and sweets provide calorie labelling, so parents can make an ‘informed’ choice. This focus on reformulation and labelling is in keeping with Public Health England’s calorie reduction programme. But is this really the food that children deserve – artificially sweetened, calorie-reduced junk? Shouldn’t popular restaurants and attractions be encouraged to make water freely and widely available and serve freshly prepared meals that include a portion – or better still, two portions – of veg with every child’s meal?



RECOMMENDATION #4: Put veg on the plate. Government should set the ambition that all children’s meals in cafés and restaurants and visitor attractions are served with two portions of veg.

We know that it can be done. All children’s meals at Jamie’s Italian include two portions of veg. Earlier this year, Prezzo launched a new children’s menu which offers two portions with every child’s meal. At River Cottage Kitchen, both adult and child meals are served with two portions. Who says treat food has to be unhealthy?

At the moment, children get 13% of their calories eating out, but only 4% of their veg. Topping this up to 13% would mean restaurants serving an extra two portions with every child’s meal.72

This doesn’t mean simply dumping an extra portion on the plate and hoping for the best – children

have to actually eat it! The Sustainable Restaurant Association has produced a toolkit for restaurants, which includes tips on how to make veg appetising to children, including by employing colour and texture, and making healthier meals more fun and appealing.

Thousands of restaurants have already pledged their commitment to putting more veg on the menu through the Peas Please initiative, coordinated by the Food Foundation. The Government should now get behind this initiative, as it related to children’s meals outside the home. The current focus from the Government on calorie labelling and reformulation to reduce calories is helpful, to a degree. The Government should articulate a more ambitious vision of children’s food outside the home, beginning with a call for all cafés, restaurants and visitor attractions to serve two portions of veg with every child’s meal.

Using quality ingredients is important to us. All of the beef, cheese and potatoes on the children’s menu are British – we know that families like to know that they are supporting British farmers, when they eat in Wetherspoon. We’re also committed to serving MSC sustainable fish and RSPCA-assured free-range eggs. We also offer organic juice on the menu as an option for the children.

We try to make it easy for families to eat well. There’s no compromise on taste, but we make sure that our children’s meals are balanced. All meals come with a portion of fruit, ensuring at least one of a child’s five-a-day. Healthy options are also signposted throughout the menu, including clearly showing salt and calorie information, making it easy for parents to understand what their kids are choosing. We pack in the vegetables and make sure that different portion sizes are on offer – for smaller and larger appetites.

Eating out can be seen as a treat; however, on many occasions, it becomes more of a convenience. Our aim is to offer ‘treat food’ which is also healthy and of a high quality. Our children’s desserts are carefully considered, with a focus on controlling portion sizes, particularly regarding sugar, salt and calorie content – to ensure that these are in line with public health targets. We don’t offer or advertise free refills of fizzy drinks to children – these drinks can blow a child’s daily sugar allowance. We make healthier drinks available, such as milk and juice, yet within the context of a delicious, appetising menu – which children thoroughly enjoy.

OLIVER ADDIS, WETHERSPOON’S FOOD DEVELOPMENT MANAGER

As a secret diner and as a parent, I was shocked by the food these chains were serving to children. Instead of tasty, healthy meals, our kids were offered sugary drinks and ‘bottomless’ puddings, and hardly any veg. I normally eat in local independent restaurants which are much better. I think that national chains need to work much harder to ensure that good food is on the menu when eating out as a family – children deserve better than this.

EURGAIN, OUT TO LUNCH SECRET DINER PARENT We know that takeaway foods can be really

unhealthy, particularly because they have a lot of sugar in them. Around our school there is much unhealthy food, including a newsagent selling sweets and energy drinks, a fish and chip shop and other takeaways. These places do ‘buy one get one free’ offers to make you buy more than you need. They offer deals which include extra unhealthy products at a cheaper price. We learnt this by surveying the shops outside our school with Food for Life. We presented our findings at a meeting with the local council and food companies and we asked for healthier foods to be more available.

ISMAEEL AND HAMMAD, 12

I am careful about the level of exposure my daughter has had to advertising and junk food marketing, but that is increasingly hard as she gets older. However, when she HAS seen colourful ads, featuring cartoon characters and catchy music, or packaging featuring appealing child-friendly designs with cartoons etc, she definitely shows more interest in those foods.

MUM WITH A 10 YEAR OLD 71

Going out for a meal is part of Britain’s culture, but instead of being a weekly ‘treat’ for families, it’s becoming the norm and contributing to the obesity epidemic. 70

DR ALISON TEDSTONE, PHE CHIEF NUTRITIONIST



In 2018, do families still eat together? Do parents and children cook together and sit around a table enjoying a shared meal?

One study published this year found that the number of families that eat an evening meal together every day has dropped from 57% of families in 2014 to just 48% in 2018.77 One in three children (34%) eat their evening meal in front of the television while around three in ten (29%) do the same for breakfast.78 Does this mean children are eating less healthily in the home than they used to? Perhaps. A 2012 study by Leeds University found that children who always ate a family meal together at a table consumed, on average, 1.5 portions more fruit and vegetables than children who never ate with their families.79

If families are eating together less often, it is partly due to the popularity of the ready meal. A full 50% of the ready meals eaten in Europe are consumed in the UK.80 With families eating a diversity of pre-prepared meals, instead of the same meal, there is less rationale to sit down together.

Our appetite for ready meals might be associated with gaps in our cooking knowledge.

A survey this year found that only four in 10 of us know more than nine recipes. Most people know only three, with sausages and mash, beans on toast and spaghetti bolognese being the most popular.81

A Food for Life parent survey conducted this year sought to understand the greatest barriers to cooking more freshly prepared meals for the family. ‘I don’t have time to cook’ was the top response parents gave; they also said: ‘Ready meals are easy and always available’ and ‘Fresh vegetables are expensive’. Three quarters of parents said they sometimes involve their children when cooking, with the most popular foods to cook together being pancakes, cakes, bacon butties, biscuits, spaghetti bolognese and pizza.

For many families, price is the most significant barrier to preparing meals from scratch at home. Almost four million children are living in households that struggle to afford to buy enough fruit, vegetables, fish and other foods to meet official dietary guidelines.82 One in four parents has skipped a meal this year to provide for their children.83

CHILDREN’S FOOD IN THE HOME

ONE IN THREE CHILDRENeat their evening meal in front of the television; around

THREE IN TEN do the same for breakfast.73

of households with children eat takeaways on a regular basis, compared with only

of adult-only households.74

THE MOST POPULAR MEALS THAT PARENTS COOK FROM SCRATCH ARE

BEANS ON TOAST AND

75

FOOD PRICES HAVE RISEN IN RECENT YEARS, with the price of fresh produce rising more sharply than many processed foods.

parents skipped a meal this year in order to provide for their children.76

It is not simply that food prices are rising, but that in recent years healthy foods have risen in price more steeply than unhealthy foods. A study comparing the price of food and drinks purchased between 2002 and 2012 found that the absolute difference in price between ‘more healthy’ foods (such as mushrooms, yoghurt, fish, grapefruit) and ‘less healthy’ foods (such as crisps, ice-cream, chocolates, sausages) widened over time.84

Healthier, unprocessed meats have risen in price more steeply in recent years than less healthy processed meats, such as meat pies, bacon, sausages, beef burgers, pork pies and ham. Fish has risen in price particularly sharply and is currently twice as expensive as beef and nearly five times more expensive than chicken.85

It should come as little surprise then that between 2007 and 2015, low income households increased their purchases of unhealthy ultra-processed foods more than any other food groups. Over this period, these households increased their purchases of cakes and pastries (6%), confectionery (4%) and processed meat products (1.5%), while significantly reducing consumption of healthier foods such as fish (-18%).86

Government data published this year show that household purchases of both fruit and fresh vegetables are lower than five years ago. Families are buying fewer fresh green vegetables than in previous years, although purchases of ultra-processed vegetables, such as baked beans, remain stable.87 Families still spend more on fruit and vegetables than any other food type, but this money buys less than it used to; consumption levels for both adults and children remain lower than is recommended.88

And it could get more difficult for families. A report from the House of Lords European Union Committee in May noted that half the UK’s food is currently imported, with 30% coming from the EU and another 11% coming from non-EU countries under the terms of trade deals negotiated by the EU. Although the terms of our departure from the European Union have not been set, the Government is committing to leaving the Customs Union. This would result in an average tariff on food imports of 22%. While this would not equate to a 22% increase in food prices for consumers, prices paid at the checkout would rise. With 40% of vegetables and 37% of fruit sold in the UK coming from Europe, fresh produce is likely to be particularly affected.89

Many families won’t be able to cope with a further rise in the price of food. UNICEF figures show that 19% of children in the UK live in a family that is ‘moderately or severely food insecure’, while 10% live in a family that is ‘severely food insecure’. On both of these measures the UK is one of, if not the,

worst performing nations in the European Union.90

But if Brexit poses a threat, it also poses an opportunity. The Government is wrangling with the greatest shake-up of agricultural policy in 50 years. This provides a rare opportunity to re-orient farm payments and practice towards the production of healthier foods. The Government must now take steps to make sure that fresh produce becomes more accessible and more affordable to families post-Brexit, otherwise the task of re-orienting children’s diets away from ultra-processed foods and towards a diet of diverse fresh and minimally processed foods will become all-the-more difficult.

Healthier, unprocessed meats have risen in price more steeply in recent years.



RECOMMENDATION #5: Make Brexit work for veg. Government should use post-Brexit farming policy to make fresh fruit and veg more accessible and affordable to children and families.

Fruit and vegetables could become less affordable for British households post-Brexit due to inflation, unfavourable exchange rates, alterations to the free movement of goods and services, the rising cost of seasonal labour, rising transportation and logistics costs, and a potential heavy tariff bill. However, the Food Foundation has suggested that a number of UK-grown fruits and vegetables could, with the right support, supply more of the UK market, thereby helping to mitigate potential price increases and volatility.91

To make veg more accessible and affordable, the Government should prioritise horticulture within the Agriculture Bill and associated agricultural policy, including by implementing financial incentives and grants to support farmers to move into or start horticultural production, with an emphasis on ecological growing techniques that support soil health and other environmental outcomes.

It should also improve access to land for new entrants in horticulture and investment in skills in ecological production methods such as organic; and ensure the sector has sufficient access to seasonal labour, including migrant labour. Further incentives to stimulate demand include public procurement and increased take up of the Healthy Start scheme; the Government should ensure that both are harnessed to boost British horticultural production.

As a mum to two boys with the eldest being three I do my best to make sure that they not only receive a balanced diet but try to ensure they are aware of food and where it comes from. It’s difficult though. I would say the biggest challenge we face in trying to cook healthy balanced meals is a combination of inspiration and time. We rely on batch cooking our own meals that can be heated up after work or searching the internet for homemade family quick recipes. Sadly, the thing that takes the time is often the preparation and also the clearing up. However, since having our boys my husband and I now eat a far better diet.

CLAIRE, MUM OF TWO BOYS

My favourite vegetable is peas and my favourite dinner is chicken nuggets, chips and broccoli. My least favourite vegetable is sweet potato because it’s too sweet.

I don’t think I’m influenced by the pictures on cereal packets or other packets. Maybe when I was younger, but now I know what I like. If there is a new food then I might see the package and want to try it, but I don’t think that will mean I like it or not.

ELEANOR, 8

I cooked with my mum once and we made mashed potato which was fun, but usually we just eat shop meals.

ANDREW, 6

I would cook more often with my children if I had more time, also if healthier ingredients were more affordable.

PARENT OF TWO BOYS

We encourage the girls to eat their vegetables, but we often find that we have to negotiate during meal times with the incentive of dessert or after meal treat. We also find it hard to avoid the convenience of fish fingers or chicken nuggets, chips and beans. Even then children can be fussy. Often one daughter will complain “I don’t like beans” so whilst one will have spaghetti hoops the other will stick with the beans. It is ongoing frustration that dinner time becomes a battle or a bargaining event and that sometimes we cook different meals for ourselves.

JONATHAN, FATHER OF TWO GIRLS


2018 TIMELINE

JANUARY – The Education Policy Institute publishes an evaluation of Universal Infant Free School Meals, finding some evidence that the policy has had a positive impact on pupil attainment, the quality of food and the uptake of school meals, particularly among Reception and KS1 pupils. However, the report warns “the current funding rates applied by the Department for Education are likely to become insufficient.” 92

Data from Public Health England’s National Child Measurement Programme is used to create the first map showing the extent of childhood obesity in England. In some regions nearly half of children are overweight, with 100,000 primary school children

now classed as ‘severely obese’.93

FEBRUARY –Public Health England launches a calorie reduction programme focussed on everyday children’s foods. Food for Life says: “Public Health England’s aspiration of making ‘the healthier choice the default choice’ is welcome, but cutting calories in processed foods is not an adequate solution. We should be looking beyond reformulation to policies that help us rediscover the joy of real, fresh, unprocessed food, eaten around a table together”.94

Analysis shows that the number of fast food outlets within five minutes’ walk of a school has increased by 67% in the space of eight years. In 2009 there were 9,700 fast food outlets nears schools, but this rose to 16,160 outlets by 2017.95

MARCH –A major report from Nuffield Trust and the Royal College of Paediatrics and Child Health, ‘International comparisons of health and wellbeing in early childhood’, reveals that the UK has one of the lowest breastfeeding rates in the world and considerably more overweight or obese children than other high-income countries.96

Supermarkets Co-op, Aldi, Lidl, Morrisons, Waitrose and Asda implement a voluntary ban on the sale of energy drinks to children under the age of 16. The ban applies to all energy drinks which contain more that 150mg of caffeine per litre.

APRIL –Hugh Fearnley-Whittingstall’s ‘Britain’s Fat Fight’ on BBC One sees Hugh challenging individuals, businesses and the Government to reverse rising rates of overweight and obesity. As part of the series, Hugh teams up with Food for Life’s Out to Lunch campaign to influence two major restaurant chains to discontinue the sale of refillable sugary drinks to children.97

New regulations governing the eligibility for free school meals under Universal Credit come into force, with the Children’s Society warning that a million children living in poverty will miss out on a meal under the new eligibility criteria.98

The Soft Drinks Industry Levy is implemented. Food for Life calls on the Government to look for fiscal incentives to reduce the use of artificial sweeteners in parallel with sugar, saying that the Government should consider extending the sugar tax to include sweeteners.99

MAY –In response to the Government’s ‘Health and Harmony’ consultation on future food and agriculture policy, Food for Life calls on the Government to re-specify the School Fruit and Veg Scheme so that a higher percentage of produce is British, local and organic.100

The draft London Food Strategy proposes a ban on junk food advertisements on Transport for London estate, while also encouraging public institutions including schools to achieve the Food for Life Served Here award.101

The Food Foundation launches ‘Veg Power’, a ground-breaking marketing fund that aims to create impactful, innovative digital campaigns promoting veg aimed at children.102

JUNE –The Government publishes the latest chapter of the Obesity Plan, setting the ambition of halving childhood obesity in England by 2030. The Plan proposes the banning of sweets and snack at checkouts, a 9pm watershed for the advertising of unhealthy food on TV, and mandatory calorie labelling on menus. Food for Life welcomes these proposals but expresses concern about political inaction on school food: “Two years on from the first Obesity Plan the Government is yet to implement any of the actions that relate to school food. This updated Plan leaves us none the wiser as to when the Healthy Rating Scheme will be developed, what Ofsted’s role will be in relation to the Scheme, and whether the Secretary of State is going to lead a campaign encouraging all academy schools to meet the School Food Standards.”

Food for Life publishes a briefing warning that trade arrangements post-Brexit could see “low-cost ultra-processed foods flood the UK market”, further fuelling dietary ill-health among children.103

JULY –Ofsted publishes a thematic review of obesity, healthy eating and physical activity in schools, finding that only 26% of schools are delivering practical cookery education and making a welcome call for Headteachers to take more ownership over school meal provision.104 Food for Life is critical of Ofsted’s reluctance to get behind a whole school approach to food, overlooking the evidence that a child’s food environment and culture, not classroom knowledge, is the primary driver of dietary behaviours. Food for Life also expresses concern about the Chief Inspector’s assertion that typical packed lunches containing processed meats, high sugar snacks and no veg are not a driver of childhood obesity.

AUGUST –Prue Leith calls for packed lunches to be banned and for schools to prioritise food education, to ensure that all children are taught to cook and to understand where food comes from.

New research from the Centre for Economics and Business Research indicates that UK food prices are likely to rise at least 5% due to the unusually hot summer, potentially exacerbating household food insecurity and dietary inequalities among children.

SEPTEMBER –Analysis shows that almost 4 million children in the UK live in households that struggle to afford to buy enough fruit, vegetables, fish and other healthy foods to meet the official nutrition guidelines.105

The Government’s long-awaited Agriculture Bill promises to “deliver a cleaner and healthier environment for future generations”, but it fails to tackle the question of how agricultural policy and payments can support healthier diets, including for children.

The Royal Society for Public Health respond to analysis showing government cuts are forcing councils to reduce their spending on critical public health services. Shirley Cramer CBE, Chief Executive, said: “This analysis shows the considerable scale and breadth of cuts to services which improve and protect the public’s health. In 2014, Simon Stevens called for “a radical upgrade in prevention”, but what we are facing is a record downgrade in funding which is already having dire consequences for the NHS. We are particularly concerned at cuts to services supporting the health and wellbeing of children and young people because we know that early intervention is so important.”

OCTOBER –Food for Life’s Out to Lunch campaign reveals that major UK attractions are failing to provide children with a single portion of veg or salad. Of the 22 attractions surveyed, only three included a portion of veg or salad in every child’s lunchbox.

NOVEMBER –The Government’s consultation proposing legislative change to prohibit the sale of energy drinks to children closes. The consultation asks whether the prohibition should apply to 16 or to 18 year olds.

DECEMBER –The Government’s consultation proposing mandatory calorie labelling on restaurant menus closes. The consultation asks whether labelling should be mandatory for all cafés and restaurants, including on children’s menus.

30 | www.foodforlife.org.uk STATE OF THE NATION: CHILDREN’S FOOD IN ENGLAND, 2018 | 31


RECOMMENDATION #1: Fix the School Fruit and Veg Scheme. The Government should re-specify the scheme so that a higher proportion of the produce is British, local and organic, and is therefore fresher, tastier, of known provenance, and more enjoyable for children.

All children aged four to six attending a state-funded school in England are entitled to receive a free piece of fruit or veg each school day through the School Fruit and Veg Scheme. This £40 million scheme represents an important investment in child health and is widely supported by teachers: a Food for Life teacher survey conducted in 2018 revealed that 92% of teachers think the scheme has the potential to increase children’s fruit and veg consumption.39 But the teachers who responded to the survey were highly critical of the quality of the produce provided. They described it as lacking in freshness, far from tasty, and frequently inedible. There is consequently a high level of waste.

“Pears are under-ripe and hard, carrots have been sweating in bags for days. Generally, the produce is not as fresh as we would hope, and this means the

children don’t eat it,” one teacher told us.

Part of the issue is the length and complexity of supply chains. A relatively small percentage of the produce provided through the scheme is British.

In response to a Freedom of Information Request, the Department for Health and Social Care conceded that only 13% of apples and 5% of pears are sourced from this country. And there’s more. Government data also shows that the produce supplied through the scheme contains higher pesticide residues than equivalent produce found on supermarket shelves, including pesticides associated with a negative effect upon children’s cognitive development.40

As any parent knows, getting children to eat their greens can be a struggle. The School Fruit and Veg Scheme provides a golden opportunity to diversify children’s tastes and instil a love of fresh produce from a young age – but it’s an opportunity that’s being squandered. There is a risk that children are being taught instead that fresh fruit and veg lacks flavour or texture and is only fit for the bin.

Re-specifying the scheme so that a higher percentage of the produce is LEAF or organic and is freshly harvested from more local supply chains would ensure that more appealing and tastier fruit and veg, with lower pesticide levels, would arrive

in schools. Teachers say that this would lead to increased consumption by children. It would also benefit British farmers and growers.

This is a timely moment to re-specify the scheme. As the UK’s departure from the European Union approaches, the Government is developing food and agriculture strategies that will aim to promote healthier eating while providing more secure markets for British farmers. A re-invigorated School Fruit and Veg Scheme provides the opportunity to further both these ambitions at once.

RECOMMENDATION #2: Invest in food in the early years. The Government should urgently review its 30 hours free childcare policy and ensure that early years settings are adequately funded to provide food. Free healthy lunches should be provided for the most disadvantaged children as part of their entitlement, in line with entitlement for free school meals.

The hidden impact of the 30 hours childcare policy on food in the early years sector is fast becoming a national scandal. By failing to invest adequately in the policy and in food provision, the Government is forcing many settings into closure, while others are discontinuing their hot meals service, fuelling inequalities in diet and health.

The lack of adequate funding for food in early years settings also represents a huge inconsistency in approach, when compared to primary school funding for school meals.

The Universal Infant Free School Meal policy was introduced on the basis of evidence that it would benefit all children’s health, development and attainment, but particularly those children most in need.

The same benefits are being denied to children in the early years, putting many children at a disadvantage before they even receive Universal Infant Free School Meals.

The Government must ensure that early years settings are properly funded to provide good care and quality food for all children taking up the 30 hours funded childcare offer. As part of this funding, the Government should, as a minimum, commit to free healthy lunches for the most disadvantaged children as part of their childcare entitlement, in line with entitlement for free school meals.

RECOMMENDATION #3: Safeguard the quality of school meals. The Government should take steps to avoid a new ‘race to the bottom’ in school meals by ringfencing Universal Infant Free School Meal budgets and giving clear guidance to procurers that quality should always be given greater weighting than cost.

There are many actions that the Government should take to safeguard the quality of school meals and improve food in schools. The Government should require procurement decisions for school meals to place a weighting of at least 60% on quality relative to cost. It should implement the commitments made in the 2016 Obesity Plan. But first and foremost, the Government must ensure that funding for school meals is spent on school meals – this means ringfencing the budget for Universal Infant Free School Meals and providing greater oversight over its spend.

The Government should also commit to the policy in the long-run. Many caterers’ business models are dependent upon Universal Infant Free School Meals. Discontinuation of the policy, as the Conservatives threatened during the 2017 General Election, would result in financial difficulties that would drive down the quality of meals and render some services unviable. One caterer stated the issue in stark terms: “If we lose Universal Infant Free School Meals, the industry dies with it.”

The Government should commit to continuing Universal Infant Free School Meals and to reviewing the funding allocation to ensure that it is properly funded for all schools. As a first step, it should ringfence the £2.30 allocation and support schools and local authorities to provide greater oversight over how this money is spent.

RECOMMENDATION #4: Put veg on the plate. Government should set the ambition that all children’s meals in cafés and restaurants and visitor attractions are served with two portions of veg.

We know that it can be done. All children’s meals at Jamie’s Italian include two portions of veg. Earlier this year, Prezzo launched a new children’s menu which offers two portions with every child’s meal. At River Cottage Kitchen, both adult and child meals are served with two portions. Who says treat food has to be unhealthy?

At the moment, children get 13% of their calories eating out, but only 4% of their veg. Topping this up to 13% would mean restaurants serving an extra two portions with every child’s meal.72

This doesn’t mean simply dumping an extra portion on the plate and hoping for the best – children have to actually eat it! The Sustainable Restaurant Association has produced a toolkit for restaurants, which includes tips on how to make veg appetising to children, including by employing colour and texture, and making healthier meals more fun and appealing.

Thousands of restaurants have already pledged their commitment to putting more veg on the menu through the Peas Please initiative, coordinated by the Food Foundation. The Government should now get behind this initiative, as it related to children’s meals outside the home. The current focus from the Government on calorie labelling and reformulation to reduce calories is helpful, to a degree. The Government should articulate a more ambitious vision of children’s food outside the home, beginning with a call for all cafés, restaurants and visitor attractions to serve two portions of veg with every child’s meal.

RECOMMENDATION #5: Make Brexit work for veg. Government should use post-Brexit farming policy to make fresh fruit and veg more accessible and affordable to children and families.

Fruit and vegetables could become less affordable for British households post-Brexit due to inflation, unfavourable exchange rates, alterations to the free movement of goods and services, the rising cost of seasonal labour, rising transportation and logistics costs, and a potential heavy tariff bill. However, the Food Foundation has suggested that a number of UK-grown fruits and vegetables could, with the right support, supply more of the UK market, thereby helping to mitigate potential price increases and volatility.91

To make veg more accessible and affordable, the Government should prioritise horticulture within the Agriculture Bill and associated agricultural policy, including by implementing financial incentives and grants to support farmers to move into or start horticultural production, with an emphasis on ecological growing techniques that support soil health and other environmental outcomes.

It should also improve access to land for new entrants in horticulture and investment in skills in ecological production methods such as organic; and ensure the sector has sufficient access to seasonal labour, including migrant labour. Further incentives to stimulate demand include public procurement and increased take up of the Healthy Start scheme; the Government should ensure that both are harnessed to boost British horticultural production.

RECOMMENDATIONS


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